ECMO联合IAPB在急性心源性休克患者急救中的应用价值及对血气状况、预后的影响  

Application value of ECMO combined with IAPB in emergency treatment of patients with acute cardiogenic shock and its influence on blood gas status and prognosis

作　　者：焦相赟 吴金海[1] 左远航 杨振坤 JIAO Xiangyun;WU Jinhai;ZUO Yuanhang;YANG Zhenkun(Department of Emergency Medicine,Nanyang First People′s Hospital,Nanyang,Henan 473000,China;Comprehensive Intensive Care Unit,Nanyang First People′s Hospital,Nanyang,Henan 473000,China)

机构地区：[1]河南省南阳市第一人民医院急诊医学科,河南南阳473000 [2]河南省南阳市第一人民医院综合重症监护室,河南南阳473000

出　　处：《检验医学与临床》2023年第21期3156-3159,共4页Laboratory Medicine and Clinic

摘　　要：目的研究体外膜肺氧合(ECMO)联合主动脉内球囊反搏(IAPB)在急性心源性休克(CS)患者急救中的应用价值及对血气状况、预后的影响。方法根据治疗方案将2019年11月至2020年11月南阳市第一人民医院收治的96例急性CS患者分为对照组(45例)和联合组(51例)。对照组给予IAPB,联合组给予ECMO联合IAPB。比较两组病情程度[采用急性生理功能和慢性健康状况评分系统Ⅱ(APACHEⅡ)和多器官功能障碍评分量表(MODS)进行评估],血气指标[血乳酸(Lac)、动脉血氧饱和度(SaO_(2))、pH值]、心功能指标[射血分数(EF)、心脏指数(CI)、每搏输出量(SV)、心输出量(CO)]、其他相关指标[B型脑钠肽(BNP)、心肌肌钙蛋白I(cTnI)、分泌型磷脂酶A2(sPLA2)、可溶性生长刺激表达因子2(sST2)]水平及住院期间病死率。结果治疗后联合组APACHEⅡ、MODS评分均低于对照组(P<0.05);治疗后联合组Lac水平低于对照组,SaO_(2)水平和pH值高于对照组,差异均有统计学意义(P<0.05);治疗后联合组EF及CI、SV、CO水平高于对照组(P<0.05);治疗后,两组血清BNP、cTnI、sPLA2、sST2水平均低于治疗前,且联合组低于对照组,差异均有统计学意义(P<0.05);联合组住院期间病死率[9.80%(5/51)]与对照组[13.33%(6/45)]比较,差异无统计学意义(P>0.05)。结论ECMO联合IAPB可改善CS患者血气相关指标,提高心功能,促进临床症状消退,降低病死风险,减轻炎症反应。Objective To investigate the application value of extracorporeal membrane oxygenation(ECMO)combined with intraaortic balloon counterpulsation(IAPB)in the emergency treatment of patients with acute cardiogenic shock(CS)and its influence on blood gas status and prognosis.Methods According to the treatment plan,96 patients with acute CS admitted to Nanyang First People′s Hospital from November 2019 to November 2020 were divided into control group(45 cases)and combination group(51 cases).The control group was given IAPB,and the combination group was given ECMO combined with IAPB.The disease degree(APACHEⅡand MODS were applied for evaluation),blood gas indexes[blood lactic acid(Lac),arterial oxygen saturation(SaO_(2)),pH value],cardiac function indexes[ejection fraction(EF),cardiac index(CI),stroke output(SV),cardiac output(CO)],disease-related indexes[B-type brain natriuretic peptide(BNP),cardiac calcium protein I(cTnI),secretory]phospholipase A2(sPLA2),soluble growth stimulating expression factor 2(sST2)levels and mortality rate during hospitalization were compared between the two groups.Results The APACHEⅡand MODS scores after treatment in the combination group were higher than those in the control group(P<0.05).After treatment,Lac level in the combination group was lower than that in the control group,while SaO_(2) level and pH value were higher than those in the control group,the differences had statistical significance(P<0.05).The levels of CO,CI,SV and EF value after treatment in the combination group were higher than those in the control group(P<0.05).After treatment,the levels of serum BNP,cTnI,sPLA2 and sST2 in both groups were lower that those before treatment,and which in the combination group were lower than those in the control group,with statistically significant differences(P<0.05).The mortality rate during hospitalization between the combination group[9.80%(5/51)]and the control group[13.33%(6/45)]had no statistically significant difference(P>0.05).Conclusion ECMO combined with IAPB can improve

关 键 词：体外膜肺氧合 主动脉内球囊反搏 心源性休克 分泌型磷脂酶A2 可溶性生长刺激表达因子2 

分 类 号：R541.64[医药卫生—心血管疾病]